Linking hospital and immigrant landing data to understand patterns of hospital use among refugees in Canada IJPDS (2017) Issue 1, Vol 1:263 Proceedings of the IPDLN Conference (August 2016)

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Edward Ng
Claudia Sanmartin
Douglas Manuel
Published online: Apr 18, 2017


In Canada, refugees represent between 10% and 15% of the total immigrant annual in-take of immigrants. Refugees are generally admitted with different selection criteria and have different settlement challenges which may lead to higher health risk, compared to other categories of immigrants. The purpose of this study is to use linked hospital and immigrant landing data to report hospitalization rates among refugees arriving to Canada between 1980 and 2006 with special focus on those from refugee-dominant source areas, namely Poland and Vietnam, and the Middle East.

Data from the 2006/07-2008/09 Discharge Abstract Database (DAD) were linked to the 1980-2008 Immigrant Landing File (ILF) to identify hospitalizations among immigrants by category of admission. Age-standardized hospitalization rates (ASHR) for overall causes (excluding pregnancy), and for selected causes are derived for refugees overall and by specific source country. Rates are compared with those for the Canadian-born population and with economic class immigrants from the same source country.

Overall, refugees had substantially lower overall ASHR compared with the Canadian-born population (494 per 10,000, 95% CI, 487, 500 vs 891 per 10,000, 95% CI, 890, 892, retrospectively). Among refugees, those who landed in Canada (refugee claimants) had the highest ASHR (539, 95% CI 524,555), especially for circulatory disease. Among refugee-dominant areas, Government-assisted refugees from the Middle East tended to have higher ASHR at levels comparable with that of the Canadian born population (for circulatory disease). Refugees had higher rates of hospitalization compared with their economic class counterparts, except among those from Poland.

Refugees, like other immigrants, generally had lower hospitalization rates compared with the Canadian born population, but the heterogeneity within groups reveals specific vulnerability for certain types of health care use.


The ELAStiC (Electronic Longitudinal Alcohol Study in Communities) project was established to determine factors that predict pathways into alcohol misuse and the life-course effects of alcohol use and misuse on health and well-being. This is achieved through accessing existing longitudinal data that are key sources of evidence for social and health policy, developing statistical methods and modelling techniques from a diverse range of disciplines, working with stakeholders in both policy, practice and the third sector to bring relevance to the work, and to bring together a diverse team of experts to collaborate and facilitate learning across diverse fields.


Methodological Innovations

Methodological developments in mechanisms for correcting bias in reporting alcohol consumption and for combining routine data with cohort data; the application of Markov models for examining the extent to which past behaviour influences future behaviour, and econometric hedonic pricing methods for providing insights into the costs of alcohol-related harm.

Pathways into Harm

Do family structure, household composition, youngsters’ previous ill-health and educational attainment predict their use of alcohol and what socio-economic factors and household transitions contribute to hazardous alcohol consumption in adults?

Secondary Harms

What is the effect on children's health and educational achievement of living in households in which one or more adults has experienced alcohol-related harm?

Mental Health & Well-Being

What is the relationship between alcohol consumption, hospital admission and mental health in adults and children?


The results of the data linkage between the multiple cohorts and health, education and police data will be reported. The challenges of linking cohort and other data types from different nations will be discussed.


Our project will aim to provide evidence that informs the UK Government's commitment to ``radically reshape the approach to alcohol and reduce the number of people drinking to excess'', by working with existing longitudinal data collected in the UK to inform policy and practice.

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